scholarly journals Colloids Yes or No? - a “Gretchen Question” Answered

2021 ◽  
Vol 8 ◽  
Author(s):  
Katja-Nicole Adamik ◽  
Ivayla D. Yozova
Keyword(s):  
Experimental Studies ◽  
Current Evidence ◽  
Term Outcome ◽  
Specific Patient ◽  
Long Term Outcome ◽  
Advantages And Disadvantages ◽  
Synthetic Colloid ◽  
Resuscitation Fluid ◽  
Species Specific

Colloid solutions, both natural and synthetic, had been widely accepted as having superior volume expanding effects than crystalloids. Synthetic colloid solutions were previously considered at least as effective as natural colloids, as well as being cheaper and easily available. As a result, synthetic colloids (and HES in particular) were the preferred resuscitation fluid in many countries. In the past decade, several cascading events have called into question their efficacy and revealed their harmful effects. In 2013, the medicines authorities placed substantial restrictions on HES administration in people which has resulted in an overall decrease in their use. Whether natural colloids (such as albumin-containing solutions) should replace synthetic colloids remains inconclusive based on the current evidence. Albumin seems to be safer than synthetic colloids in people, but clear evidence of a positive effect on survival is still lacking. Furthermore, species-specific albumin is not widely available, while xenotransfusions with human serum albumin have known side effects. Veterinary data on the safety and efficacy of synthetic and natural colloids is limited to mostly retrospective evaluations or experimental studies with small numbers of patients (mainly dogs). Large, prospective, randomized, long-term outcome-oriented studies are lacking. This review focuses on advantages and disadvantages of synthetic and natural colloids in veterinary medicine. Adopting human guidelines is weighed against the particularities of our specific patient populations, including the risk–benefit ratio and lack of alternatives available in human medicine.

Menstrual, Sexual, and Obstetrical Outcomes after Vaginal Replacement for Vaginal Atresia Associated with Anorectal Malformation

2016 ◽  
Vol 27 (06) ◽  
pp. 495-502 ◽  
Author(s):  
Clare Skerritt ◽  
Alejandra Vilanova Sánchez ◽  
Victoria Lane ◽  
Richard Wood ◽  
Geri Hewitt ◽  
...  
Keyword(s):  
Anorectal Malformation ◽  
Outcome Data ◽  
Current Evidence ◽  
Vaginal Agenesis ◽  
Vaginal Reconstruction ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Vaginal Atresia ◽  
Rectovestibular Fistula

Background The authors of this article became aware of significant differences in the management of two females with a rectovestibular fistula and associated vaginal agenesis. In one patient, a sigmoid colovaginoplasty was performed at the time of the posterior sagittal anorectoplasty (PSARP), and the other underwent repair of the rectovestibular fistula with a primary PSARP, but the surgeons elected to delay the timing of vaginal reconstruction. We decided to review the literature, to establish if recommendations could be made to optimize the management of these children based on current evidence. Methods A literature review was conducted to determine the management and long-term outcomes in patients with an anorectal malformation and associated vaginal atresia. Specific gynecological outcomes assessed were menstrual egress and adequacy of the vaginal replacement for penile–vaginal intercourse. Results Eighty-eight cases were included in the review. Age at diagnosis had a bimodal distribution: 0 to 5 years, 56%; >10 years, 37%. Vaginal atresia was recognized before the operation in 45 patients. Types of vaginal atresia encountered were: (a) distal vaginal atresia (n = 17), (b) vaginal agenesis with absent Mullerian development (n = 47), (c) vaginal agenesis with variable Mullerian development (n = 17), and (d) cervico-vaginal agenesis (n = 7). Types of vaginal replacement used were sigmoid colovaginoplasty (n = 26), distal rectal fistula as neovagina (n = 30), terminal ileum (n = 5), vaginal pull-through (n = 9), and others/unknown (n = 8). Two patients followed a perineal dilatation program and nine patients await reconstruction. Median follow-up was 18 months (6 weeks to 31 years). Long-term menstrual outcomes were reported in 18 (21%) patients. Sexual function was reported in 10 (11%) patients. Three pregnancies were reported but none resulted in live births. Conclusion Vaginal atresia is often missed in association with ARMs. Management should be in collaboration with pediatric gynecologists. Due to a lack of long-term outcome data, no definite conclusion can be drawn for the best technique, tissue, or timing of vaginal replacement. The opportunity to perform vaginal replacement in conjunction with the rectal repair may be worth considering because of a shallower pelvis, nonscarred tissue planes, and the excellent surgical exposure.

Catheter-based treatment of ilio-femoral deep vein thrombosis - an update on current evidence

VASA ◽  
2013 ◽  
Vol 42 (3) ◽  
pp. 161-167 ◽  
Author(s):  
Jennifer Fahrni ◽  
Rolf P. Engelberger ◽  
Nils Kucher ◽  
Torsten Willenberg ◽  
Iris Baumgartner
Keyword(s):  
Deep Vein Thrombosis ◽  
High Rate ◽  
Current Evidence ◽  
Bleeding Complications ◽  
Postthrombotic Syndrome ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Vein Thrombosis ◽  
Deep Vein

Ilio-femoral deep vein thrombosis (DVT) has a high rate of long-term morbidity in the form of the postthrombotic syndrome (PTS). Therefore, management of acute thrombosis should not only focus on the prevention of acute complications such as propagation or embolisation of the initial clot but also on preventing PTS and recurrent thrombosis. Contemporary catheter-based treatments of deep vein thrombosis have proven to be safe and effective in selected patients. Current guidelines recommend medical therapy with anticoagulation alone for all but the most severe, limb-threatening thrombosis. They additionally allow for consideration of catheter-based treatment in patients with acute DVT and low risk of bleeding complications to prevent PTS. Recent studies favoring interventional therapy have not been included in these guidelines. Data on long-term outcome is expected to be published soon, clarifying and very likely strengthening the role of catheter-based treatments in the management of acute ilio-femoral DVT.

FETAL ANAESTHESIA: IS THIS NECESSARY FOR FETOSCOPIC THERAPY?

2010 ◽  
Vol 21 (1) ◽  
pp. 24-35 ◽  
Author(s):  
MARC VAN DE VELDE ◽  
FREDERIK DE BUCK ◽  
TIM VAN MIEGHEM ◽  
LEONARDO GUCCIARDO ◽  
PHILIP DE KONINCK ◽  
...  
Keyword(s):  
Stress Response ◽  
Preterm Infants ◽  
Premature Infants ◽  
Patient Population ◽  
Invasive Procedures ◽  
Term Outcome ◽  
Specific Patient ◽  
Long Term Outcome ◽  
Outstanding Work

Since Robinson and Gregory demonstrated the need to administer analgesia to preterm infants and the safety of such anaesthestic techniques in this specific patient population, pain in neonates and adequate analgesia have drawn more and more attention. Thanks to the outstanding work by Anand et al, it became increasingly clear that premature infants experience stress during invasive procedures and that as a consequence long-term neurodevelopmental status may be affected. Fetuses also demonstrate a stress response. Fetal analgesia can be administered efficiently, eliminating the fetal stress response. However, it remains unclear whether this results in improved neurodevelopment and improved long term outcome.

Prenatal Treatment of Congenital Adrenal Hyperplasia: Long-Term Effects of Excess Glucocorticoid Exposure

2018 ◽  
Vol 89 (5) ◽  
pp. 362-371 ◽  
Author(s):  
Svetlana Lajic ◽  
Leif Karlsson ◽  
Anna Nordenström
Keyword(s):  
Congenital Adrenal Hyperplasia ◽  
Experimental Studies ◽  
External Genitalia ◽  
Prenatal Treatment ◽  
Adrenal Hyperplasia ◽  
Long Term Effects ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Negative Effect

Prenatal treatment of congenital adrenal hyperplasia with dexamethasone (DEX) has been in use since the mid-1980s and has proven effective at reducing virilization of external genitalia in affected girls. However, multiple experimental studies on animals and clinical studies on humans show that prenatal administration of glucocorticoids may cause unwanted adverse effects which have raised concerns about the long-term safety of the treatment. The long-term outcome of prenatal DEX treatment on cognition has been investigated, but the results are still conflicting. Overall, most of the evidence points towards a negative effect on executive functions where girls seem to be more susceptible than boys. Some effects on social behavior have been observed, but results are still contradictory and treated children are mostly well adapted. Cardiovascular, renal, and metabolic function are still areas to be investigated. Larger studies are warranted to investigate areas other than cognition and behavior and to be able to draw more definitive conclusions about prenatal DEX treatment.

Fresh versus Frozen Embryo Transfer in PCOS: Arguments for and Against

2017 ◽  
Vol 35 (04) ◽  
pp. 359-363
Author(s):  
Daimin Wei ◽  
Zi-Jiang Chen ◽  
Jinlong Ma
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Randomized Trials ◽  
Frozen Embryo Transfer ◽  
Current Evidence ◽  
Obstetric Outcomes ◽  
Fresh Embryo Transfer ◽  
Term Outcome ◽  
Long Term Outcome

AbstractIn vitro fertilization (IVF) is a common infertility treatment for women with polycystic ovarian syndrome (PCOS) who have failed to conceive in ovulation induction and who have other concomitant infertility factors. Women with PCOS tend to have an excess response to ovarian stimulation during IVF. Freeze-all strategy with deferred frozen embryo transfer was initially used to prevent ovarian hyperstimulation syndrome (OHSS) in patients with a high risk. New evidence from randomized trials showed elective frozen embryo transfer in PCOS women with a low risk of OHSS could also lower the incidence of OHSS, improve live birth rate mainly by decreasing pregnancy loss, and increase birth weight of singleton infants compared with fresh embryo transfer. However, the risk of preeclampsia was higher after frozen than fresh embryo transfer. Observational studies and limited randomized trials showed the risks of other obstetric outcomes and long-term safety profile after frozen embryo transfers were at least as good as that after fresh embryo transfer. Summarily, current evidence showed elective freeze-all and frozen embryo transfer is generally superior to fresh embryo transfer to achieve live birth in women with PCOS; however, its effect on obstetric outcome and long-term outcome warrants further studies.

scholarly journals Predicting Phrenic Nerve Palsy in Patients Undergoing Atrial Fibrillation Ablation With the Cryoballoon—Does Sex Matter?

2021 ◽  
Vol 8 ◽  
Author(s):  
Alexander Pott ◽  
Hagen Wirth ◽  
Yannick Teumer ◽  
Karolina Weinmann ◽  
Michael Baumhardt ◽  
...  
Keyword(s):  
Recovery Time ◽  
Nerve Palsy ◽  
Female Gender ◽  
Current Evidence ◽  
Patient Specific ◽  
Phrenic Nerve Palsy ◽  
Term Outcome ◽  
Long Term Outcome ◽  
First Time

Background: Phrenicus nerve palsy (PNP) is a typical complication during pulmonary vein isolation (PVI) using the cryoballoon with the ominous potential to counteract the clinical benefit of restored sinus rhythm. According to current evidence incidence of PNP is about 5–10% of patients undergoing Cryo-PVI and is more frequent during ablation of the RSPV compared to the RIPV. However, information on patient specific characteristics predicting PNP and long-term outcome of patients suffering from this adverse event is sparse.Aim of the Study: To evaluate procedural and clinical characteristics of AF patients with PNP during cryoballoon PVI compared to patients without PNP.Methods and Results: Between 2013 and 2019 we included 632 consecutive AF patients undergoing PVI with the cryoballoon in our study. 84/632 (13.3%) patients experienced a total number of 89 PNP during the ablation procedure. 75/89 (84%) cryothermal induced PNP recovered until the end of the procedure (transient PNP, tPNP), whereas 14/89 (16%) PNP hold beyond the end of the procedure (non-transient PNP, ntPNP). Using multivariate logistic regression, we found that sex and BMI are strong and independent predictors of cryothermal induced non-transient PNP during cryoballoon PVI with an odds ratio of 3.9 (CI: 95%, 1.1–14.8, p = 0.04) for female gender. Interestingly, all patients (14/14, 100%) with a non-transient PNP experienced complete PNP resolution after a mean recovery time of 68 ± 79 days.Conclusion: Our data indicate for the first time, that female sex and lower BMI are independent predictors for non-transient PNP caused by cryoballoon PVI. Fortunately, during follow up all PNP patients resolved completely with a median recovery time of 35 days.

scholarly journals Comparison of Different Timing of Multivessel Intervention During Index-Hospitalization for Patients With Acute Myocardial Infarction

2021 ◽  
Vol 8 ◽  
Author(s):  
En-Shao Liu ◽  
Cheng Chung Hung ◽  
Cheng-Hung Chiang ◽  
Chia-His Chang ◽  
Chin-Chang Cheng ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Current Evidence ◽  
Index Hospitalization ◽  
Term Outcome ◽  
Term Survival ◽  
Long Term Outcome

Background: Many patients presenting with acute myocardial infarction (AMI) were found to have a multivessel disease. Uncertainty still exists in the optimal revascularization strategy in AMI patients. The purpose of this study was to assess the outcome of immediate multivessel revascularization compared with staged multivessel percutaneous coronary intervention (PCI) in patients with AMI.Method: This was a nationwide cohort study of 186,112 patients first diagnosed with AMI, 78,699 of whom received PCI for revascularization. Patients who received repetitive PCI during the index hospitalization were referred to as staged multivessel PCI. Immediate multivessel PCI was defined as patients with two-vessel PCI or three-vessel PCI during the index procedure. Cox proportional hazards regression models were performed to evaluate the different indicators of mortality risks in AMI.Result: Immediate multivessel PCI was associated with a worse long-term outcome than staged multivessel PCI during the index admission (log-rank P < 0.001). There was a higher incidence of stroke in patients with multivessel PCI during hospitalization. In Cox analysis, immediate multivessel PCI was an independent risk factor for mortality compared to those with staged multivessel PCI, regardless of the type of myocardial infarction.Conclusion: This study demonstrated that performing immediate multivessel PCI for AMI may lead to worse long-term survival than staged multivessel PCI. Our findings emphasized the importance of PCI timing for non-infarct-related artery stenosis and provided information to supplement current evidence.

Incorporation of a Comprehensive Pediatric Thrombosis Program into the Multidisciplinary Care Team for Children with Congenital Heart Disease: A Prospective Cohort Study.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4062-4062
Author(s):  
Mary Patricia Massicotte ◽  
Ivan M. Rebeyka ◽  
Mary Bauman ◽  
Lesley G. Mitchell ◽  
Alf Conradi
Keyword(s):  
At Risk ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Prospective Cohort ◽  
Congenital Heart ◽  
Current Evidence ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Risk For Thrombosis

Abstract BACKGROUND: Over the last 10 years, children with congenital heart disease (CHD) have been experiencing increased survival due to diagnostic and surgical techniques. However, associated with this is a requirement for prolonged central venous access which has serious associated sequelae, of which thrombosis is one of the most important. In a busy comprehensive cardiovascular program, the diagnosis, treatment and management of children with or at risk for thrombosis is extremely demanding and constantly changing based on current evidence based recommendations. The Stollery Children’s Hospital, a member of the Western Canadian Children’s Heart Network (WCCHN), is the cardiovascular surgical centre for children with CHD from British Columbia, Manitoba, Alberta, and Saskatchewan An expert Pediatric Thrombosis Team has been incorporated into the multi disciplinary management of children with CHD. This team is dedicated entirely to the diagnosis, management and long term followup of children requiring anticoagulation. MATERIALS/METHODS: A standard approach to the diagnosis, management and long term followup of children with CHD with or at risk for thrombosis was initiated. The Pendragon data base was custom designed to prospectively collect the following data on all children: demographics, treatment and long term outcome. RESULTS: Since the inception of the Thrombosis service (Oct 2003) there have been 325 children who required cardiac surgery with 40% (n=129) of these children requiring Thrombosis consultation. The 4 most common causes for Thrombosis referral have been primary prophylaxis post CHD surgery including mechanical valves, Blalock Taussig shunts, and Fontan procedures, 51% (n=66), suspected CVL related thrombosis 26% (n=33), arterial catheter related thrombosis (catheterization or monitoring) 16% (n=19), and extracorporeal membranous oxygenation 9% (n=11). By Oct 2004, it is anticipated that 300 children will have been consulted on. CONCLUSIONS: The 1st year results of the data collected on this prospective cohort will be presented including demographics, reason for anticoagulation, diagnosis, and long term outcome.

Current evidence for prenatal and postnatal corticosteroids in preterm infants

2021 ◽  
pp. fetalneonatal-2020-319706
Author(s):  
Eric S Shinwell ◽  
Polina Gurevitz ◽  
Igor Portnov
Keyword(s):  
Adverse Effects ◽  
Inhaled Corticosteroids ◽  
Standard Of Care ◽  
Current Evidence ◽  
Antenatal Corticosteroids ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Beneficial Effects ◽  
Potential Risks

Antenatal corticosteroids undoubtedly save many lives and improve the quality of many others. However, the currently accepted dosage schedule has been in place since 1972, and recent studies have suggested that beneficial effects may be seen with less. Most but not all studies of long-term outcome show no adverse effects. The use of antenatal corticosteroids in women with COVID-19 raises important questions regarding potential risks and benefits. However, currently, most authorities recommend continuing according to published guidelines. With regard to postnatal corticosteroids, alternatives to systemic dexamethasone, the somewhat tainted standard of care, show promise in preventing bronchopulmonary dysplasia without adverse effects. Systemic hydrocortisone and inhaled corticosteroids are of note. The mixture of surfactant and corticosteroids deserves particular attention in the coming years.

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